Athletics and Herbal Supplements

Athletes’ use of herbal supplements has skyrocketed in the past two decades. At the top of the list of popular herbs are echinacea and ginseng, whereas garlic, St. John’s wort, soybean, ephedra and others are also surging in popularity or have been historically prevalent. According to a publication by the American Botanical Council, herbal supplement sales grossed $5.3 billion in the United States during 2011, a 4.5 percent increase from the preceding year. Despite their increasing popularity, recent events have illuminated possible concerns regarding efficacy and safety of herbal supplements. Remarkable sports performances at the end of the 20th century raised suspicions about supplement use by athletes, prompting the formation of the World Anti-Doping Agency, or WADA. Shortly thereafter, the deaths of two professional athletes raised concerns that an herbal supplement, ephedra, may have contributed to their deaths. These events and others have prompted clinicians and scientists to reevaluate the role of herbal supplements in athletics.

The meaning of the term herbal supplement is itself nebulous. Some use it to refer to products derived directly from plants, whereas others use it to mean any product containing molecules of botanical origin, such as caffeine pills. Herbal supplements are variously called botanicals, phytomedicines, dietary supplements, nutritional supplements or nutraceuticals. In this article, the term herbal supplement refers to plant-derived products containing multiple bioactive chemicals, with some exceptions for products of fungal or bacterial origin (which are technically not “herbal” but are often treated the same).

Although industry has kept pace with athletes’ interests and simultaneously spurred them, research has lagged behind and many questions linger. Why do athletes consume these herbs? Do they use the product as directed on the label or by a doctor? What claims are made about these supplements, and does clinical research support them? How can scientists and sports medicine personnel best design experiments to answer these questions, and what obstacles do they encounter?